Wiki What's included in 97750 (FCE)

betsycpcp

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We have a provider billing functional capacity evaluations in workers' comp claims, and there is confusion over how to determine the amount of units that should be billed. We know that it's 15 minutes per unit, and CPT guidelines including the CPT Assistant state that the amount of time in direct contact with the patient determines the amount of units to be reported.

This provider is including time spent on the phone with the employer (with the injured worker present) getting information on the worker's job duties. He is also including time after the testing is done, for post testing instructions. This may include instructing them on home exercises. The August 2013 CPT Assistant does says time spent on "post testing instructions" is included, but we need details on what that would entail.

Does anyone have experience with this or have any reference that specifies what can be included? This provider bills more units than most, and we are not sure what exactly is legitimate to do as part of the FCE. I've checked the forums here and searched on Google but I'm not finding much. All I've found is a document from the Academy of Orthopaedic Physical Therapy – Current Concepts in Functional Capacity Evaluation -- that says to tell the worker what to do or who to contact if they have significant symptoms after the exam, but it doesn't say anything about home exercises for example.

Thanks in advance for any information anyone can share.
 
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